The emergency physicians had been practicing as a corporation contracted with the hospital for more than 25 years, while the hospital billed for their professional services as part of a single bill. Payers were used to having a single claim to adjudicate and patients never saw a second bill from the emergency physicians. This arrangement had paid the physicians well over the years, until the hospital grew concerned that the arrangement was not fully optimized for revenue capture of the physicians’ services. The physician contract cost more than the revenue that came in and the hospital was ready for a change.
Like most healthcare institutions, the hospital had always been sensitive to patients’ billing concerns. Though convinced that separate billing was prudent (and profitable), administrators expressed their concerns that patients, upset by receiving a second bill, might negatively affect their reputation, revenue and satisfaction scoring.
Intelligent Practice Solutions
To help the group, Brault provided this assistance, from our full suite of Intelligent Practice Solutions.
Patient Engagement (Advocacy Center)
Acknowledging a possible uptick in unhappy patients, Brault implemented their toll-free call and advocacy services, in which service representatives could access contract summary, billing policy and payer payment information needed to educate patients and explain billing charges, payments and outstanding balances.
Callers were calmly and courteously reassured that the center would advocate directly with the insurance company to pay the claim, and that uncovered items, such as copays and deductibles, would be their only responsibility. Callers were also informed about convenient self-service options, such as 24-hour phone and online payment processing, and billing-statement review.
Outcome and Results
Despite the hospital’s worries, the wave of angry patients never materialized. In fact, the overall result of the emergency group’s separate agreement was net neutral–no increase in ED billing complaints.
Through its extensive experience in patient engagement and education, Brault preempted a potentially damaging service issue, effectively positioning the call center as a helper and advocate, instead of a bureaucratic adversary.
“We thought ED billing complaints would go through the roof. But thankfully, that never happened. Brault’s Patient Advocacy Center gets much of the credit.”
— Practice CEO